Freckles

Freckles are small, flat, round spots caused by uneven distribution of melanin in the skin. They usually appear in clusters, are all much the same colour as each other, and sit on sun-exposed areas - face, neck, arms, shoulders and the backs of the hands.

They are most common in people with fairer complexions and in those with a genetic predisposition, and they typically first appear in childhood. Freckles darken after sun exposure and often fade over winter.

Freckles are benign. There is nothing medically wrong with having them, and plenty of people have no interest in removing them. This page is for those who want them reduced.

When a brown spot is not a freckle

This is the part worth reading carefully. Several other things look like freckles:

• Solar lentigines (age spots) - larger, usually appear after 40, do not fade in winter
• Seborrhoeic keratoses - raised, waxy, stuck-on in appearance
• Melasma - larger patches rather than discrete spots
• Lentigo maligna - an early form of melanoma that can present as a slowly enlarging flat brown patch on sun-damaged skin, most often on the face of an older person

The last one is why we examine pigmented spots before treating them. A spot that is larger than your other freckles, a different colour from them, irregular in border, changing, or new in adulthood is assessed rather than lasered - because laser destroys the tissue and leaves nothing for pathology. See skin cancer and mole removal.

Treatments used for freckles

• Laser and light - Nd:YAG, erbium, Fraxel, CO2 and IPL are all used, chosen by skin type and the depth and density of pigment
• Cryotherapy - for individual assessed lesions
• Chemical peels
• Depigmenting lotion treatments
• Cosmeceutical skincare, including retinoids and antioxidants
• Microdermabrasion and epidermal levelling
• Skin needling

Some topical treatments used for pigmentation are prescription-only and require a doctor's consultation.

What results are realistic

Freckles usually lighten rather than disappear, and they commonly come back with sun exposure. Because freckles are driven by UV and genetics, and the genetics do not change, sun protection is what determines whether a result lasts.

Most people need more than one session. Individual results vary with skin type, the density of freckling and sun habits.

If you would rather not treat them at all, mineral make-up gives cover and physical sun protection without altering the skin. That is a legitimate choice, not a lesser one.

Risks

• Redness, swelling and crusting after treatment
• Blistering
• Hypo-pigmentation - lighter patches where freckles were, which can be permanent and can look more conspicuous than the freckles did
• Post-inflammatory hyper-pigmentation, more likely in darker skin types
• Scarring
• Infection
• Incomplete clearing and recurrence
• Increased sun sensitivity after treatment

See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Dermal skin treatments start from $130. Treatment is quoted after assessment and is not covered by Medicare.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Related: hyper-pigmentation, age spots, sun damage, all skin conditions.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.